Procedure: Central Venous Access Device: Removing A Non-Tunneled .
PRO: Central Venous Access Devices - Removing a Non-Tunneled Central Venous Catheter Approved by NPC May 17th, 2018 NATIONAL INSTITUTES OF HEALTH CLINICAL CENTER CLINICAL CENTER NURSING DEPARTMENT Procedure: Central Venous Access Device: Removing a Non-Tunneled Central Venous Catheter SUMMARY OF SIGNIFICANT CHANGES SINCE LAST REVIEW Added description of how CVAD length is measured and where it is documented. Included appendix with pictures to illustrate measurement points. Reference list cleaned and updated Minor format/verbiage Changes Included information regarding removal of apheresis catheter Information added for HAI Prevention Bundle o Wiping of bedside area before using Clinical Nurse Specialist: Primary Stakeholder(s): Deletes or Replaces - Ellen Eckes Jamie Kerns CVAD Removing a Non-Tunneled Central Venous Catheter (05/12) (66 KB) PRO 1
PRO: Central Venous Access Devices - Removing a Non-Tunneled Central Venous Catheter Approved by NPC May 17th, 2018 NATIONAL INSTITUTES OF HEALTH CLINICAL CENTER CLINICAL CENTER NURSING DEPARTMENT Procedure: Central Venous Access Device: Removing a Non-Tunneled Central Venous Catheter Approved: //s// Gwenyth R. Wallen, PhD, RN Acting Chief, Clinical Center Nursing Department Formulated: Implemented: Reviewed: Revised: 4/1995 6/1995 10/2008, 11/2009, 5/2012, 8/2015, 4/2018 4/1996, 7/1998, 5/1999 (implemented 6/1999), 2/2001, 5/2001, 12/2001, 10/2002, 02/2003, 10/2003; 05/2005, 10/2008, 11/2009, 5/2012, 9/2016, 4/2018 2
PRO: Central Venous Access Devices - Removing a Non-Tunneled Central Venous Catheter Approved by NPC May 17th, 2018 Procedure: Central Venous Access Device; Removing a Non-Tunneled Central Venous Catheter Essential Information 1. 2. 3. 4. Central Venous Access Device (CVAD) Care and Maintenance Competency is required. A medical order to remove a Central Venous Access Device (CVAD) is required. Please check coagulation and platelets before removal of any central line. Review from VAD structured note titled: Central VAD Insertion/Removal/Repair in chart to obtain total length of catheter. This note is entered by VAD at time of procedure and is measured from hub to tip. External length is measured from hub to insertion site (in cm). 5. Chlorhexidine may cause a chemical burn if it is not allowed to completely dry prior to application of skin prep or dressing. Equipment 1. Sterile, disposable suture removal set (if necessary) 2. Mask 3. Sterile Scissors (if culturing catheter tip) 4. Non-Sterile gloves 5. 4 X 4s (3 pkgs.) 6. One Chlorhexidine/alcohol applicator (ChlorPrep ) (3mL) 7. Sterile gloves 8. Transparent sterile occlusive dressing 9. Sterile drape/barrier 10. Alcohol pads (optional) 11. Sterile specimen container (if culturing catheter) 12. Goggles (optional) 13. Water resistant pad (optional) Steps: 1. Key Points/Rationale: Position the patient in bed at a 10-20 degrees Trendelenburg position. If patient cannot tolerate Trendelenburg, recline the patient in the supine position.1-3 1. Trendelenburg position elevates venous pressure above atmospheric pressure, reducing the risk of air entry into the wound. Have patients perform Valsalva maneuver to increase intrathoracic pressure. 2. 3. 4. 5. If a femoral line is being removed, positioning the patient in a bed is required. Apply mask. Prepare the environment by wiping surfaces with hospital approved wipes per CCND Policy Perform hand hygiene. 2. Central lines should NOT be removed with the patient in a non-reclining chair or upright position. N/A 3. 4. N/A 5. See Appendix B Minimizes microbial bioburden of the area. 3
PRO: Central Venous Access Devices - Removing a Non-Tunneled Central Venous Catheter Approved by NPC May 17th, 2018 Steps: 6. 7. 8. 9. 10. 11. 12. 13. 14. Key Points/Rationale: Set up sterile field and put on non-sterile gloves. Remove the dressing and anchoring devices other than sutures. Remove non-sterile gloves and perform hand hygiene. Put on sterile gloves Cleanse exit site area around catheter insertion and sutures with chlorhexidine/alcohol swab applicator using a bidirectional scrub. 6. N/A 7. Remove sutures, if present. Fold two 4 x 4 gauze pads in half and place over the catheter exit site If removing an internal jugular (IJ) or subclavian (SC) or thoracic apheresis line: a. Place patient at 10-20 degrees position. b. Patient should be instructed to perform a Valsalva maneuver or to hold their breath.3 c. If patient is unable to follow commands, (e.g. the ventilated patient) remove catheter during end exhalation.3 d. While holding slight pressure over the site, slowly and steadily remove the catheter If removing femoral lines or femoral apheresis lines: a. Position patient flat in bed b. Patient should be instructed to perform a Valsalva maneuver or to hold their breath.3 c. If patient is unable to follow commands, (e.g. the ventilated patient) remove catheter during end exhalation.3 d. While holding pressure over the site, slowly and steadily remove the catheter. 11. 12. Patients should be instructed to turn head away from insertion site or put mask on.1, 3 Hands could become contaminated when removing old dressing. N/A Chlorhexidine/alcohol swab applicators should be applied to the site as follows: a. 30 seconds for dry surgical sites such as arm or abdomen. b. 2 minutes for moist sites such as inguinal or femoral. c. Allow site to dry completely. Do not blot, blow, fan, or wipe dry. N/A N/A 8. 9. 10. 13. Educate patient on how to perform Valsalva maneuver and anticipatory teaching about catheter removal. If resistance is met while pulling the catheter, stop, apply dressing, and notify the Licensed Independent Practitioner (LIP). 14. Educate patient on how to perform Valsalva maneuver and anticipatory teaching about catheter removal. If resistance is met while pulling the catheter, stop, apply dressing, and notify the LIP. 4
PRO: Central Venous Access Devices - Removing a Non-Tunneled Central Venous Catheter Approved by NPC May 17th, 2018 Steps: Key Points/Rationale: If removing a PICC: a. Position patient’s arm so it is gently extended outwards. b. Grasp the catheter just below the hub and withdraw the PICC, re-grasping catheter closer to insertion site with removal.3 c. Using a gentle downward motion, steadily remove catheter away from the body toward the patient’s hand. d. If resistance is encountered, stop catheter withdrawal, reposition patient’s arm, and try again. e. If resistance persists, cover the insertion site with a temporary sterile dressing and apply a warm pack to the upper arm for 15-30 minutes to relax the spasm and allow easier catheter removal.51,3 Reattempt removal. If a catheter tip is to be cultured, hold it over sterile specimen container and using sterile scissors, cut a two (2) inch segment of the tip. Cover the container and send to the lab at the completion of the dressing change. 15. 17. When catheter is out, apply firm pressure to the catheter exit site until hemostasis has been achieved. a. If bleeding is noted, continue to apply pressure, checking at 5minute intervals until hemostasis has occurred b. Measure length from hub to tip 17. 18. Once hemostasis has occurred, apply fresh sterile gauze and a sterile transparent occlusive dressing over the gauze.1-3 18. 15. 16. 19. The patient must remain in bed/chair for the following time periods: a. PICC, Subclavian, and Internal Jugular between 30 minutes to one hour. b. Femoral lines – a minimum of one hour with assessment of bleeding/hematoma every fifteen minutes.3 c. Reassess site after patient has been out of If 2nd attempt fails, cover site with temporary sterile dressing, notify LIP and do not reattempt catheter removal. 16. 19. It is important to maintain homeostasis, so catheter tip can be placed on sterile field until homeostasis is obtained, or a second nurse could assist at this point to obtain catheter tip for culture and ensure homeostasis maintained. Always inspect catheter tip to ensure it is intact, smooth and not jagged and that the length corresponds to total catheter length upon insertion for lines placed at NIH.2,3 For lines placed outside of NIH with no documentation of total catheter length inspect the tip for uneven, jagged edges which may indicate a broken catheter. If you suspect a broken catheter obtain order for chest x-ray. Patients should be advised not to cough, laugh or sneeze post catheter removal If patient develops symptoms of air embolism; sudden dyspnea, pallor, tachycardia or coughing, place patient immediately on left side in Trendelenburg position, call a code and stat page the LIP. Once hemostasis achieved, head of bed (HOB) may be elevated 30 degrees. 5
PRO: Central Venous Access Devices - Removing a Non-Tunneled Central Venous Catheter Approved by NPC May 17th, 2018 Steps: 20. 21. Key Points/Rationale: bed. For outpatients – Instruct the patient to leave the dressing in place for a minimum of 24 hours and to check the dressing every few hours for signs of bleeding. For inpatients – Dressing should be changed 24 hours post catheter removal and site assessed every 4 hours until site is epithelialized.2 Apply new dressing as needed. Document in approved electronic medical record. 20. If bleeding is noted, instruct the patient/family member to hold pressure over the site and call the responsible LIP for further instructions. 21. N/A References: 1. Infusion Nurses Society. (2011). Infusion Nursing Standards of Practice. Journal of Infusion Nursing, 34 (1Suppl) S57-59. 2. Infusion Nurses Society. (2011). Policies and Procedures for Infusion Nursing, (4th Ed.): 9294. 3. Camp-Sorrel, D. (Ed). (2011). Chapter II. Vascular Access Devices. In Access Device Guidelines- Recommendations for Nursing Education and Practice, 3rd Ed., (pp. 8t). Oncology Nursing Society, PA: Pittsburgh. Contributing Policy, Procedure, Standard of Practice: 1. SOP: CVAD 2. PRO: CVAD Dressing Change 3. CCND Hospital Acquired Infection (HAI) Prevention Policy 6
PRO: Central Venous Access Devices - Removing a Non-Tunneled Central Venous Catheter Approved by NPC May 17th, 2018 Appendix A How to measure length of catheter Measure all catheters to the body of catheter. Red Beginning of body of catheter Non-tunneled catheter Red exit site Blue external catheter length Tunneled catheter Orange exit site Blue external length 7
PRO: Central Venous Access Devices - Removing a Non-Tunneled Central Venous Catheter Approved by NPC May 17th, 2018 Appendix B How to Perform Hand Hygiene 8
Infusion Nurses Society. (2011). Infusion Nursing Standards of Practice. Journal of Infusion Nursing, 34 (1Suppl) S57-59. 2. Infusion Nurses Society. . NIH Clinical Center, Clinical Center Nursing Department, CCND, Nursing Practice Documents, Procedures and Standards of Practice, Procedure, PRO, Central Venous Access Device (CVAD), Procedure .
The VICI VENOUS STENT System has been sterilized with ethylene oxide. Contents One (1) VICI VENOUS STENT Delivery System INTENDED USE The VICI VENOUS STENT is intended for the treatment of obstructions and occlusions in the venous vasculature. INDICATIONS FOR USE The VICI VENOUS STENT System is indicated for improving luminal diameter
management and removal of central venous access devices (CVAD) and long peripheral venous catheters (Long PVC) [also known as 'Midlines'] within the WA Country Health Service (WACHS). Note: While this Clinical Practice Standard (CPS) is regarding venous access devices, a minor appendix relating to arterial ports is included in lieu of a .
This policy is to provide information on central venous access devices that are used at The Christie, to ensure patients receive the most appropriate device, the devices are managed correctly and any complications related to them are minimised as much as possible. A central venous access device is defined by the internal portion of the
Management of a central venous access device at a glance. Care of the patient requiring a central venous access device (CVAD) may be highly complex, due to the risk of infection and air embolism to the patient. This guide has been developed to ensure that patients with a CVAD receive safe and high ‑quality
An implanted port is a central venous access device, often referred to - as a Port-a-cath . These are useful for long term vascular access. They are designed to permit repeated access to the venous system for the parenteral delivery of medications, fluids, and nutritional solutions and for the sampling of venous blood.
CENTRAL VENOUS CATHETER ACCESS DEVICE (CVAD) MANAGEMENT . This LOP is developed to guide clinical practice at the Royal Hospital for Women. Individual patient circumstances may mean that practice diverges from this LOP. Introduction . DEFINITIONS OF TYPES & SITES . CVAD may also be called a Central Venous Line or Central Venous Catheter (CVC .
Policies and Procedures: Central Venous Catheters – PICC, Short Term, Tunneled, I.D. #1042 Implanted - Blood Withdrawal Page 2 of 10 Peripherally Inserted Central Catheter (PICC): A central venous access device inserted into a peripheral vein whose tip dwells in the superior vena cav
Many community courts handle criminal cases only, but others are experimenting with a broader range of matters, including juvenile delinquency and housing code violations. Some community courts were initiated by courts, and some have been championed by a district attorney. These differences reflect a central aspect of community courts: they focus on neighborhoods and are designed to respond to .
